横行結腸双孔式傍ストーマヘルニアに対して腹腔鏡下に修復を行った1例

A case of parastomal hernia adjacent to a double barrel transverse colostomy repaired by laparoscopic surgery

◆要旨：患者は70代の男性．横行結腸双孔式人工肛門造設術3か月目より傍ストーマヘルニアおよび人工肛門脱出を認めた．次第に症状が悪化しストーマパウチの貼付が困難になってきたため，同術5か月目に腹腔鏡下傍ストーマヘルニア修復術を施行した．経過良好のため術後9日目に退院となった．双孔式人工肛門に合併した傍ストーマヘルニアの修復例の報告は少なく，治療法として確立されたものは存在しないと考えられる．今回筆者らは，Sugarbaker法を腹腔鏡下に横行結腸双孔式人工肛門に応用することで根治を得ることができた．

A man in his seventies who had undergone a transverse double-barrel colostomy was referred to our hospital for regular checkup. He complained of a swelling around the colostomy and prolapse of the colostomy 3 months after the colostomy surgery, and we diagnosed him as having a parastomal hernia with stomal prolapse. These symptoms gradually worsened and it was difficult to secure an ostomy pouch. We finally performed laparoscopic parastomal hernia repair 2 months after he was diagnosed. He was discharged from the hospital on postoperative day 9 without any complications. Only a few reports have described parastomal hernia repair for cases of double-barrel colostomy, therefore, there were no established techniques to repair it. In this case, we were able to successfully repair the hernia by improving the Sugarbaker method under laparoscopy.